Provider Demographics
NPI:1013376656
Name:SPICER, WAYNE JR (LCSW)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:SPICER
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1847
Mailing Address - Country:US
Mailing Address - Phone:217-801-1242
Mailing Address - Fax:
Practice Address - Street 1:1030 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-9200
Practice Address - Country:US
Practice Address - Phone:217-930-2106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2016-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0182351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical